This inspection was unannounced and took place on 10 and 11 November 2015.

The Dene Lodge is registered to provide accommodation and personal care for up to 30 people. The home specialises in the care of older people and provides support for some people living with dementia. At the time of this inspection there were 22 people living at the home.

Within the home is the Exmoor unit which is a secure unit for five people living with advanced dementia. There is a member of staff present at all times. People are encouraged and supported to join in the activities in the main home.

At the last inspection of the home no concerns were identified with the care being provided to people.

There is a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People, staff and visitors felt the service was well led by an enthusiastic and approachable manager. The registered manager was seen to be involved in the daily lives of people in the home. They knew people very well. People told us they could rely on them to “sort things out.”

People were supported by sufficient numbers of staff to meet their needs in a relaxed and unhurried manner. When people needed staff attention they responded promptly. People said staff would come and help whenever they needed them. Staff numbers were consistently maintained and there were always senior staff available to support care staff and people living in the home.

People were supported by kind and caring staff. All comments about staff were very positive. One person said “The staff are very nice. Very kind. They are friendly and do their best. It is nice to be here.” Another person told us “They are ever so kind. I couldn’t do without them.”

We visited the Exmoor unit for people living with dementia. People were relaxed and happy. People were used to kindness. They were able to move freely about the unit and looked “at home” there.

People’s health was monitored and it was clear from their comments and care records that appropriate action was taken when people were unwell. Staff in the home worked with other health professionals to ensure people’s health needs were met.

People were very positive about the meals served in the home. Staff assisted people to order their choice of meals. Mealtimes were sociable and enjoyable.

People were able to take part in a range of activities according to their interests. Staff encouraged and supported people to enjoy their days in the home.

The Dene Lodge provides accommodation with personal care for up to 33 people. The home provides a service for older people and within the home there is a unit (The Exmoor unit) which cares for five people who are living with dementia.

At the last inspection in November 2015, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

People remained safe at the home. People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. There were policies and procedures in place which minimised the risks of abuse to people. Where concerns had been raised the registered manager had worked in partnership with relevant organisations to make sure people were safe. One person who lived at the home said “I feel safer here than I did in my own home.” Some people who were living with dementia were unable to tell us whether they felt safe. However, people looked relaxed and comfortable in their surroundings.

People continued to receive effective care and support because staff had the skills and knowledge to meet their needs. When required, staff assisted people to access health and social care professionals to ensure they received the care and treatment they needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The home continued to provide a caring service to people. Staff were kind and respectful when they interacted with people. One person who lived at the home said “This is my home and [name of registered manager] and the staff are more like my family. It is wonderful; excellent.” Systems were in place to make sure people’s wishes and preferences during their final days and following death were understood and respected.

The home continued to be responsive to people’s needs and preferences. People were assessed before they made the decision to move to the home. This helped to ensure the home was able to meet a person’s needs and preferences. Care plans contained important information about a person’s social history which helped staff to get to know people. People were able to make choices about their day to day lives and there were plenty of opportunities for social stimulation.

The home continued to be well-led. The registered manager had managed the home for many years and was well respected by the people who lived in the home, staff and people’s relatives. A person who lived at the home said “She’s amazing. One of a kind. So caring and committed.” A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There were systems in place to monitor the quality of the service provided and to seek people’s views.

The inspection was carried out by one adult social care inspector, who answered the five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found the service to be safe because people were treated with respect and dignity by the staff. People were safe because the service had an effective system to manager accidents and incidents and learn from them so they were less likely to happen again. This reduced the risks to people and helped the service to continually improve.

When people were at risk, staff followed effective risk management policies and procedures to protect them. Staff supported people to take informed risks with minimal necessary restrictions to as far as possible protect their welfare.

The manager was in the process of re-assessing the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) for people who use the service and was having discussions with local authorities about this. This meant that people were protected from discrimination and their human rights were protected.

People received their medicines as prescribed. Prescribed medicines (including controlled drugs) were stored and administered safely in line with current and relevant regulations and guidance.

The staffing levels were sufficient to meet people’s identified needs. People were safe because the service considered skill mix and experience when arranging staffing.

Is the service effective?

We found the service to be effective because there was an advocacy service available if people needed it, this meant when required people could access additional support.

Care plans reflected people’s current individual needs, choices and preferences. People’s health was regularly monitored to identify any changes that may require additional support or intervention.

Staff supported people to take informed risks with minimal necessary restrictions. The environment enabled staff to meet people’s diverse care, cultural and support needs.

Staff had effective support, induction, supervision and appraisal.

Is the service caring?

We found the service to be caring because people were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people’s needs when they needed it.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. Appropriate professionals were involved in planning, management and decision making.

Staff knew the people they were caring for and supporting. People were as independent as they wanted to be. People we spoke with said, “I couldn’t be in a better place” and “I couldn’t have better care.” Staff we spoke with said, “Everyone’s so friendly.”

Is the service responsive?

We found the service responsive because, where appropriate, a person’s capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. Advocacy support was provided when needed.

People had their individual needs regularly assessed and met. There were arrangements in place to speak to people about what was important to them.

People completed a range of activities in and outside the service regularly. People had access to activities that were important and relevant to them and were protected from social isolation. Staff told us, “They say what they want and we respect this.” People told us, “If you ask for something and it’s not available, as soon as it is, they remember” and “It’s brilliant here.”

Is the service well-led?

There was a registered manager in post on the day of our visit and all other conditions of registration were met.

The service generally worked well with other agencies and services to make sure people received their care in a joined up way. However, we saw that one person had not been referred to a dietician although this had been identified as a need in the person’s care plan.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly.

Concerns and complaints were used as an opportunity for learning or improvement.

People received a good quality of support. Each person was encouraged to express their views and live as they wished. We saw that people had full and varied social lives where they wished.

Staff were knowledgable about people’s support needs and treated people respectfully. They were supportive and patient. They explained and reassured people where necessary.

People we spoke with told us that they were happy living at the service and felt safe. One person told us they “like it here” and “I can't really find fault”. One person told us they “love the view from my room” and “I get on with all the staff”.

People and their families were encouraged in developing their care plans. We saw that all care plans described each person’s individual needs and preferences in clear language.

Complaints and concerns were listened to and acted upon immediately.

There were 27 people living in the home at the time of our visit. We met and spoke with seven people who used the service, a relative and two visitors to the home. We spoke with five staff who were on duty at the time of the visit. We looked at the care records for four people and the recruitment records for four staff. We also reviewed records relevant to the management and the administration of the service. We spoke with a social care professional who came in regular contact with the service.

People we spoke with were very happy with the support they had from staff and the home. One person said, “Glad I came here.” Another said they felt “looked after.” Visitor’s told us that the care provided at the home had had a big impact on the person they came to visit. They said,” looks well and is doing wonderfully.”

We saw people had been supported to be dressed appropriately in clean and cared for clothing. We saw that people had had assistance if needed to brush their hair and maintain their nails. Staff ensured that where people chose to or needed to, they were wearing their glasses, hearing aids and jewellery. This showed that staff maintained peoples welfare and promoted their well-being.

People we spoke with expressed that they felt safe living in the home. They told us they were able to speak to staff if they had any concerns or worries. People said the staff were “lovely”,” friendly” and “helpful.” Visitors told us that staff “always made us feel welcome.”

We carried out this inspection in response to concerns raised with us. We were informed that people who lived at the home were not being given choices about the time they got up and had breakfast and that, on occasions, staff treated people disrespectfully. During our visit we found no evidence to substantiate the concerns expressed to us.

People we asked said that they were able to decide what time they got up and when they went to bed. One person told us “I pretty much do as I please. I usually go down to breakfast between 8.30 and 9.” Another person said “The staff bring me my breakfast when I’m ready. Sometimes I go to the dining room and other times I have it in my room, depends how I feel.”

We observed that people were free to come to the dining room when they felt ready. The last person to arrive in the dining room was served breakfast at about 9.30am.

People we spoke with were very complimentary about the staff who supported them. Comments included; “Staff are always polite,” “All the staff are very kind” and “Staff are all wonderful, patient and kind, there is never a cross word.” Everyone we asked said that they had never been shouted at or witnessed any member of staff shout.

Some people who live at The Dene Lodge were unable to fully express their views but all appeared comfortable and content. People who were able to express their views told us that it was a nice place to live. One person said that it was “Excellent” another said “I think it’s the best home in the county.”

People said that they were able to make choices about their day to day lives. They said that they could decide what time they got up, when they went to bed and how they spent their day. One person said “I was told it’s my home now so I must do as I choose.”

People said there were plenty of activities to join in with if they wished to, but could spend time quietly in their rooms if they preferred.

Visitors spoken with said that staff were ‘kind and approachable.’ People living at the home said that staff were always happy to help and came quickly when called.

Everyone asked said that the home made sure they saw health and social care professionals according to their individual needs. Staff said that they assisted people to attend appointments outside the home.